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General NPI Number Information
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NPI Number | 1023853173
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Entity Type | Individual
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Provider Name | HARPER BREANN GILLENTINE OD
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Gender | Female
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Dates
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Enumeration Date | 06/29/2024
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Last Update Date | 08/07/2025
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Provider Practice Location Address
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Address Line | 1626 N LITCHFIELD RD STE 110
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City | GOODYEAR
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State | AZ
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Zip | 85395-1399
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Country | US
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Telephone | 713-797-1010
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Fax |
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Provider Business Mailing Address
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Address Line | 63 S ROCKFORD DR STE 220
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City | TEMPE
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State | AZ
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Zip | 85288-6226
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Country | US
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Telephone | 602-598-7491
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 11111TG
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPT-002866
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License Number State | AZ
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